Trimethoprim-Sulfamethoxazole vs Sulfamethoxazole for Acute Urinary Tract Infections in Children

Abstract

\s=b\A total of 118 children between 6 months and 10 years of age with acute urinary tract infection were treated in a random; double-blind manner with 12 mg/kg/day of trimethoprim-sulfamethoxazole (61 patients) or 50 mg/kg/day of sulfamethoxazole (57 patients) for ten days. Mean trimethoprim and sulfamethoxazole susceptibilities of Escherichia coli isolated from these patients were 1.2 and 0.6 \g=m\g/ml,respectively. Mean serum concentrations of trimethoprim and sulfamethoxazole were 1.8 and 62 \g=m\g/ml, respectively, one hour after the dose. Of the children who completed the ten days of prescribed medication, clinical and bacteriological cure was confirmed immediately after treatment for all but one patient in each group. Most patients in each treatment group with recurrent infections had underlying urological abnormalities. Severe hematological, renal, or hepatic toxicity requiring interruption of treatment was not encountered. No advantage of trimethoprim-sulfamethoxazole over sulfamethoxazole alone for acute urinary tract infection was demonstrated. (Am J Dis Child 132:1085-1087, 1978) Sul fonami des are the most fre¬ quently recommended drugs for treatment of acute urinary tract Accepted for publication June 6, 1978. From the Department of Pediatrics, University of Texas Southwestern Medical School, Dallas. Dr J.B. Howard is now with the Hospital Calvo Mackenna, Universidad de Chile, Santiago. Dr J.E. Howard is now with the Cl\l=i'\nicaPediatrica, Universidad de Brasilia. Reprints not available. infections in infants and children. Escherichia coli and other coliform bacilli causing these infections are usually susceptible to sulfonamides. The combinations of trimethoprim, an inhibitor of dehydrofolate reductase, with sulfamethoxazole has beenclaimed to produce better therapeutic results in adults, especially in those situations in which there is a substan¬ tial incidence of sulfonamide-resistant strains of E coli.1'' To assess the possible superiority of the combina¬ tion of trimethoprim-sulfamethoxa¬ zole over sulfamethoxazole alone in the treatment of acute urinary tract infections in children, the following study was undertaken in the outpa¬ tient clinic of Children's Medical Center, Dallas. PATIENTS AND METHODS Infants and children of either sex and of any ethnic background with acute urinary tract infection who could be kept under medical observation for 42 days were enrolled in the study. Patients were between 6 months and 10 years of age. They had developed symptoms and signs of acute urinary tract infection within 72 hours and had not taken any antibacterial medication within the previous week. Chil¬ dren with chronic or recurrent urinary tract infections were excluded.At the initial visit, a history and physical examination, determination of complete blood cell count, SGOT level, and serum creatinine level, routine urinalysis, and urine culture were done. In infants under 2 years of age, urine for culture was obtained by suprapubic bladder aspiration. In the older children, a clean-catch, midstrea...

A survey of the management of urinary tract infection in children in primary care and comparison with the NICE guidelines

“…This is consistent with the results of a large Dutch family practice cohort study [28]. Three randomized control trials which compared the effectiveness of different oral antibiotics in lower UTI in children reported no significant difference between treatments [29-31]. NICE do not recommend a specific antibiotic for 'blind' treatment, but instead suggest that the choice should be based upon locally developed multidisciplinary guidance.…”

Cotrimoxazole and neonatal kernicterus: a review

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Inhibition of Folate Metabolism in Chemotherapy

“…In the treatment of acute uncomplicated UTI of childhood, it has been shown to be as effective as ampicillin (ELLERSTEIN et al 1977), and sulfamethoxazole (HOWARD and HOWARD 1978;FELDMAN et al 1975). In the treatment of acute uncomplicated UTI of childhood, it has been shown to be as effective as ampicillin (ELLERSTEIN et al 1977), and sulfamethoxazole (HOWARD and HOWARD 1978;FELDMAN et al 1975).…”